Simple prediction scores predict good and devastating outcomes after stroke more accurately than physicians

Introduction
Physicians are often asked to prognosticate soon after a patient presents with stroke. This study aimed to compare two outcome prediction scores (Five Simple Variables [FSV] score) and the PLAN (Preadmission dependence and comorbidities, Level of consciousness, Age, and focal Neurologic deficit) with informal prediction by physicians.

Methods 
Demographic and clinical variables were prospectively collected from consecutive patients hospitalized with acute ischaemic or haemorrhagic stroke (2012 to 2013). In-person or telephone follow-up at 6 months established vital and functional status (modified Rankin score [mRS]). Area under the receiver operating curves (AUC) was used to establish prediction score performance.

Results
Five hundred and seventy five patients were included; 46% female, median age 76 years, 88% ischaemic stroke. Six months post-stroke 47% of patients had a good outcome (alive and independent, mRS score 0-2) and 26% a devastating outcome (dead or severely dependent, mRS 5-6). The FSV and PLAN scores were superior to physician prediction (AUCs of 0.823-0.863 vs. 0.773-0.805, p<0.0001) for good and devastating outcomes. The FSV score was superior to the PLAN score for predicting good outcomes and vice versa for devastating outcomes (p<0.001). Outcome prediction was more accurate for those with later presentations (>24 hours from onset).

Conclusion
The FSV and PLAN scores are validated in this population for outcome prediction after both ischaemic and haemorrhagic stroke. The FSV score is the least complex of all developed scores and can assist outcome prediction by physicians.